Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
JACC Cardiovasc Interv. 2018 Sep 24;11(18):1848-1858. doi: 10.1016/j.jcin.2018.06.045.
The aim of this study was to compare the changes of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) with severity of epicardial coronary stenosis between nonculprit vessel of acute myocardial infarction (AMI) and stable ischemic heart disease (SIHD).
There has been debate regarding the reliability of FFR or iFR for nonculprit stenosis in the acute stage of AMI.
A total of 100 AMI patients underwent comprehensive physiologic assessment including FFR, iFR, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) for nonculprit vessel stenosis after primary percutaneous coronary intervention (PCI) for culprit vessel. The changes in FFR and iFR for diameter stenosis (%DS) of nonculprit vessel stenosis were compared with FFR and iFR measured in 203 patients with SIHD.
From 40% to 80% stenosis, FFR and iFR measured in nonculprit vessel of AMI patient showed significant decrease with worsening stenosis severity (all p values < 0.001). Nonculprit vessels of AMI patients showed lower CFR than SIHD; however, IMR was not different between the nonculprit vessel of AMI and SIHD patients. FFR and iFR were not significantly different between the nonculprit vessel of AMI and SIHD patients in all %DS groups from 40% to 80% (all p values > 0.05). In addition, percent difference of FFR and iFR according to the increase in %DS was also not significantly different between nonculprit vessel of AMI or SIHD. There was no significant interaction between clinical presentation and the changes of FFR and iFR for worsening %DS (interaction p value = 0.698 and 0.257, respectively).
Changes in FFR and iFR for the nonculprit stenosis of AMI patients were not significantly different from those in SIHD patients. These data support the use of invasive physiological parameters to guide treatment of nonculprit stenoses in the acute stage of successfully revascularized AMI.
本研究旨在比较急性心肌梗死（AMI）非罪犯血管和稳定型缺血性心脏病（SIHD）患者中，心外膜冠状动脉狭窄严重程度与分流量储备（FFR）或瞬时无波比（iFR）变化之间的关系。
关于 AMI 急性期非罪犯狭窄时 FFR 或 iFR 的可靠性一直存在争议。
100 例 AMI 患者在初次经皮冠状动脉介入治疗（PCI）治疗罪犯血管后，对非罪犯血管狭窄行全面生理评估，包括 FFR、iFR、冠状动脉血流储备（CFR）和微血管阻力指数（IMR）。比较非罪犯血管狭窄的直径狭窄程度（%DS）的 FFR 和 iFR 变化与 203 例 SIHD 患者的 FFR 和 iFR。
从 40%到 80%狭窄，AMI 患者非罪犯血管的 FFR 和 iFR 随狭窄严重程度的恶化而显著降低（均 p 值<0.001）。AMI 患者的非罪犯血管 CFR 低于 SIHD，但 AMI 和 SIHD 患者的 IMR 无差异。在 40%至 80%的所有 %DS 组中，AMI 和 SIHD 患者的非罪犯血管的 FFR 和 iFR 均无显著差异（均 p 值>0.05）。此外，根据 %DS 增加，FFR 和 iFR 的百分比差异在 AMI 或 SIHD 的非罪犯血管之间也无显著差异。临床表型与 FFR 和 iFR 对恶化 %DS 的变化之间无显著交互作用（交互 p 值分别为 0.698 和 0.257）。
AMI 患者非罪犯血管的 FFR 和 iFR 变化与 SIHD 患者无显著差异。这些数据支持使用有创生理参数来指导成功血运重建后的 AMI 急性阶段的非罪犯狭窄治疗。
